Delivering language fMRI at scale: the experience of the Australian Epilepsy Project

Language fMRI is increasingly used in the presurgical evaluation of epilepsy and tumor patients, but its use nonetheless remains limited by the need for specialized expertise in data acquisition, processing and interpretation. The Australian Epilepsy Project (AEP) is a national scale research project collecting imaging, cognitive and genetics data in up to 4,000 participants, with language fMRI collected across multiple sites and reported back to referring neurologists. To achieve this, the AEP has developed standardized methods for data acquisition, processing, and interpretation. This includes telehealth-based cognitive task training for participants, a centralized data processing pipeline, automated analysis of language laterality, and manual review of cases flagged as atypical upon automated review. This approach makes language fMRI a widely accessible clinical tool, expanding its use beyond specialized centers to a broader patient population.